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Biomedical subjects

E Solima

Publications and source records attributed to E Solima.

9 recordsLinked to original sources
PubMed2000

Is local anesthesia an affordable alternative to general anesthesia for minilaparoscopy?

STUDY OBJECTIVE: To determine if minilaparoscopy under local anesthesia is at least as reliable and affordable as that performed under general anesthesia. DESIGN: Prospective, randomized study (Canadian Task Force classification I). SETTING: University-affiliated hospital. PATIENTS: One hundred sixty-four consecutive women evaluated for infertility. INTERVENTION: Diagnostic minilaparoscopy performed after women were randomized to receive general or local anesthesia with conscious sedation. MEASUREMENTS AND MAIN RESULTS: Levels of postoperative pain measured by visual analog scale; volume of CO(2) used; length of procedure, complete pelvic evaluation, and hospitalization; complications; and pathologic diagnosis were evaluated. The groups were comparable in age, years of infertility, and symptoms. For women receiving local anesthesia, 5.5% required general anesthesia to complete the procedure. Women in both groups required postoperative analgesics. The groups had no statistically significant differences in pain level 1 hour after the procedure, number of complications, and pelvic pathology. Patients who had local anesthesia required a smaller volume of CO(2) (p <0.01) and their hospitalization was significantly shorter (p <0.01). However, in 15% of these women pelvic visualization was incomplete, compared with 7.2% in the general anesthesia group. CONCLUSION: Minilaparoscopy performed under local anesthesia was as reliable and affordable as when performed under general anesthesia.

Adult↗
PubMed1999

Pain mapping during minilaparoscopy in infertile patients without pathology.

STUDY OBJECTIVE: To draw a map of pelvic pain and quantify the level of provoked pain during minilaparoscopy under local anesthesia and conscious sedation. DESIGN: Observational study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Twenty infertile women. INTERVENTIONS: Minilaparoscopy was performed under local anesthesia and conscious sedation, and cognitive performance was evaluated with the Rey auditory verbal learning task. MEASUREMENTS AND MAIN RESULTS: The diagnostic procedure was performed with one 2-mm micrograsper and one 2-mm microprobe to evaluate the pelvis. In particular we grasped utero-ovarian ligaments; we touched, grasped, and distended fallopian tubes with blue dye; we moved the uterus with a manipulator inserted at the cervix; and we touched and grasped bowel and omentum. Level of pain was recorded on a visual analog scale. Patients had no pathologic findings, including minimal endometriosis and pelvic adhesions. The highest level of pain was recorded when we distended the tubes. No pain was elicited when we touched and grasped ovary, omentum, and bowel. In 10% of women when we stretched the tubo-ovarian ligament we provoked a minimal vagal reaction. CONCLUSION: Minilaparoscopy under conscious sedation for pelvic pain mapping in women without pain or pathology revealed consistently negative findings, validating the value of this measurement. (J Am Assoc Gynecol Laparosc 6(1):51-54, 1999)

Adult↗
PubMed1998

Outpatient diagnostic hysteroscopy.

STUDY OBJECTIVE: To evaluate the feasibility, validity, indications, and results of a large series of diagnostic hysteroscopies performed without anesthesia. DESIGN: Retrospective analysis of hysteroscopy charts performed between 1989 and 1996 (Canadian Task Force classification II-2). SETTING: University-affiliated endoscopy unit. PATIENTS: Four thousand consecutive women referred for different indications. INTERVENTIONS: Diagnostic hysteroscopy was performed in 91% of patients without premedication or anesthetics. In some women premedication or general or local anesthesia was required to access the uterine cavity. MEASUREMENTS AND MAIN RESULTS: The success rate, validity indication, complication rate, and number of biopsies were critically evaluated and assessed in relation to increased experience of operators. In 91% of women we accessed the uterine cavity at the first attempt without premedication, whereas 207 (5. 1%) patients required local anesthesia and 99 (2.4%) premedication. Only 1.6% required general anesthesia. In 52% intrauterine pathology was diagnosed and in 21% further surgical treatment was suggested. CONCLUSION: Hysteroscopy was feasible when performed in an outpatient setting without general or local anesthesia in more than 90% of women. The operator's experience seems a key factor both for accurate endometrial evaluation and to reduce failure and endometrial biopsy rates. The low frequency of further surgical treatment justifies performing the procedure in the office.

Adolescent↗
PubMed1996

Costs and Benefits of Office Diagnostic Hysteroscopy

In Italy, the main location for performing diagnostic hysteroscopy is the office. The success of office hysteroscopy is related to savings of time and money and the convenience for the physician and patient. We evaluated 4000 diagnostic hysteroscopies performed between January 2, 1989, and March 1, 1996. In 17.8% of these patients we subsequently performed operative hysteroscopies (metroplasty, synechiolysis, myomectomy, polypectomy for polyps >2 cm), and in 5.2% a total abdominal hysterectomy for abnormal uterine bleeding or endometrial cancer. The low percentage of operations underlines the efficacy of office diagnostic hysteroscopy, especially if we evaluate costs and accuracy of this procedure in detecting uterine pathologies.

Journal Article↗
PubMed1996

Correlation between Ultrasonographic Findings and Laparoscopic Appearance in Patients with Laparoscopically Treated Ovarian Cysts

We performed laparoscopy in 96 women (64 age <40 yrs, 22 > 40 yrs) with a diagnosis of ovarian cyst. The size and morphology of each mass were established, and color flow Doppler characteristics were determined by ultrasonography. Laparoscopically we evaluated the external and internal surfaces and vascularization. The laparoscopic appearance confirmed the ultrasonographic findings in 85% of women.

Journal Article↗
PubMed1996

Microlaparoscopy

Seventy-five women underwent diagnostic office laparoscopy under local anesthesia using a 1.9-mm microlaparoscope. Indications were infertility (40), pelvic pain (25), and uterine malformation (septate or bicornuate uterus) (10). All women tolerated the procedure well. In only two we could not evaluate the pelvic organs because of severe adhesions. Visualization of the pelvic organs was reasonable, although the size of the video image was smaller than the one obtained by laparoscopy. Operating time was 10 to 20 minutes. We believe that this is a safe, simple, effective, fast, and inexpensive way to evaluate pelvic disease and to obtain histologic samples.

Journal Article↗
PubMed1994

Hysteroscopic Appearance of Benign and Malignant Endometrial Polyps. What are the Differences?

The objective of this study is to evaluate the differences between benign and malignant endometrial polyps at hysteroscopy. In our collected experience of 1793 diagnostic hysteroscopies performed from December 1989 to December 1993, we found 3 malignant polyps in 151 cases of hysteroscopically diagnosed endometrial polyps. The differences in appearance of the malignant polyps are mainly represented by surface irregularities such as necrosis, vascular irregularities and whitish thickened areas. We conclude that when these patterns are present it is better to perform a targeted biopsy to confirm the hysteroscopic diagnosis. This approach allows selection of patients that can be treated by hysteroscopic polypectomy from those who require more radical treatment.

Journal Article↗